1,720,971 research outputs found
Abbiamo bisogno di nuovi target glicemici nel management del diabete gestazionale?
Full text linkABSTRACT Background: Allo stato attuale, non esistono evidenze solide circa i target glicemici da impiegare nel management del Diabete Gestazionale, tanto che le raccomandazioni internazionali sono ancora eterogenee. Scopo: verificare l’appropriatezza e la sicurezza dei target glicemici attualmente raccomandati nel management del diabete gestazionale in termini di nati Large for Gestational Age e di outcome neonatale avverso. Obiettivo secondario è valutare il ruolo di BMI pregestazionale, incremento ponderale e tipo di terapia prescritta sui suddetti outcome e sul controllo glicemico. Metodi: studio osservazionale, in cui sono state coinvolte donne con diagnosi di GDM (criteri IADPSG) seguite presso l’ambulatorio ‘Diabete & Gravidanza’ dell’Ospedale S. Andrea tra il 2016 e il 2019. Criteri di esclusione: età < 18 anni, anticorpi anti-GAD positivi o diabete pregestazionale noto, HbA1c >6%, BMI<18 Kg/m2, gravidanze gemellari, qualunque patologia o trattamento abbia nota interferenza con il metabolismo dei glucidi. Le glicemie puntiformi delle pazienti sono state classificate in “in target” quando <90 mg/dl a digiuno e 130 mg/dl un’ora dopo il pasto e “out target” quando ≥90 mg/dl e >130 mg/dl e per ciascuna paziente e per ciascun punto è stato calcolato un indice critico ovvero il numero di valori di glicemia sopra il target rispetto al totale dei valori a disposizione. Tali dati ed i principali fattori clinici-antropometrici delle pazienti sono stati messi in relazione con i nati LGA e l’outcome avverso compositum mediante la data analysis, l’analisi RECPAM (RECursive Partitioning and Amalgamation) e la statistica inferenziale. Risultati: sono state analizzate 386 donne con i relativi profili glicemici, per un totale di 40844 glicemie in analisi. Sono state identificate quattro categorie naturali di glicemia a digiuno (<78,2mg/dl; ≥78,2 mg/dl e <84 mg/dl, tra 84 e 89 e ≥90) e cinque per la glicemia post-prandiale (<91 mg/dl; 91-105 mg/dl; 105,1-117 mg/dl; 117,1-129,9 mg/dl;>130 mg/dl). Le pazienti del gruppo con glicemie più elevate facevano avevano più spesso bambini LGA ed outcome avversi, facevano più ricorso all’insulina, erano più spesso obese o sovrappeso, avevano valori di HbA1c maggiori al terzo trimestre e avevano un incremento ponderale più spesso inadeguato (p=0,001). Le mappe concettuali fornite dalla “data analysis” hanno identificato 3 cluster di pazienti raggruppate in modo omogeneo e distinto a seconda delle glicemie e degli outcome: le pazienti con glicemie a digiuno e post prandiali incluse nelle prime 2 categorie naturali mostravano outcome migliori di quelle con glicemie più elevate con un andamento lineare. L'analisi RECPAM e le analisi di regressione confermavano il ruolo giocato dall'iperglicemia (>84 mg/dl) come fattore di rischio indipendente per lo sviluppo di LGA (OR 2,3; IC 95% 1,1-3,8; p=0,016) con BMI>25 Kg/m2 (OR 2,1; CI95%1,7-4,6; p=0,019), mentre la glicemia post-prandiale (>117 mg7dl) ed il tipo di trattamento (dieta/insulina) non avevano influenza. Quando nel modello veniva inserito anche l'incremento ponderale non adeguato (OR 2,1; CI95%1,7-4,6; p=0,019), l'iperglicemia a digiuno perdeva di significato. Conclusioni: I target glicemici attualmente raccomandati dalle società scientifiche internazionali e la loro modalità di applicazione sembrano troppo poco stringenti per la prevenzione degli outcome avversi materno-neonatali nelle pazienti affette da GDM, in particolare con riferimento al tasso di neonati LGA
Continuous subcutaneous insulin infusion (CSII) in diabetic pregnancy: a review RECENT PATENTS ON ENDOCRINE, METABOLIC & IMMUNE DRUG DISCOVERY
No full textRECENT PATENTS ON ENDOCRINE, METABOLIC & IMMUNE DRUG DISCOVE
Codice rivista: E194263
Titolo rivista: RECENT PATENTS ON ENDOCRINE, METABOLIC & IMMUNE DRUG DISCOVERY
Issn: 1872-2148
Cordiali saluti
CINECA - Servizio Gestione Rivist
Glucokinase deficit prevalence in women with diabetes in pregnancy. a matter of screening selection
Full text linkIntroduction: The prevalence among pregnant women with diabetes of monogenic diabetes due to glucokinase deficit (GCK-MODY) varies from 0 to 80% in different studies, based on the chosen selection criteria for genetic test. New pregnancy-specific Screening Criteria (NSC), validated on an Anglo-Celtic pregnant cohort, have been proposed and include pre-pregnancy BMI <25 kg/m2 and fasting glycemia >99 mg/dl. Our aim was to estimate the prevalence of GCK-MODY and to evaluate the diagnostic performance of NSC in our population of women with diabetes in pregnancy. Patients and Methods: We retrospectively selected from our database of 468 diabetic pregnant patients in Sant'Andrea Hospital, in Rome, from 2010 to 2018, all the women who received a genetic test for GCK deficit because of specific clinical features. We estimated the prevalence of GCK-MODY among tested women and the minimum prevalence in our entire population with non-autoimmune diabetes. We evaluated diagnostic performance of NSC on the tested cohort and estimated the eligibility to genetic test based on NSC in the entire population. Results: A total of 409 patients had diabetes in pregnancy, excluding those with autoimmune diabetes; 21 patients have been tested for GCK-MODY, 8 have been positive and 13 have been negative (2 of them had HNF1-alfa mutations and 1 had HNF4-alfa mutation). We found no significant differences in clinical features between positive and negative groups except for fasting glycemia, which was higher in the positive group. The minimum prevalence of monogenic diabetes in our population was 2.4%. The minimum prevalence of GCK-MODY was 1.95%. In the tested cohort, the prevalence of GCK-MODY was 38%. In this group, NSC sensitivity is 87% and specificity is 30%, positive predictive value is 43%, and negative predictive value is 80%. Applying NSC on the entire population of women with non-autoimmune diabetes in pregnancy, 41 patients (10%) would be eligible for genetic test; considering a fasting glycemia >92 mg/dl, 85 patients (20.7%) would be eligible. Discussion: In our population, NSC have good sensitivity but low specificity, probably because there are many GDM with GCK-MODY like features. It is mandatory to define selective criteria with a good diagnostic performance on Italian population, to avoid unnecessary genetic tests
Assistenza alla donna con diabete pregestazionale e gestazionale
No full textIl diabete complica dall’8 al 25% delle gravidanze a seconda degli studi e delle popolazioni, e rappresenta la più frequente complicanza non ostetrica. La maggior parte delle donne è affetta da diabete gestazionale e solo circa l’1% è affetta da diabete pregestazionale, sia tipo 1 che tipo 2; sia il diabete gestazionale che il diabete tipo 2 sono in progressivo aumento con l’incremento dell’obesità nel nostro paese soprattutto nella popolazione più giovan
L'effetto dell'allattamento sul metabolismo glucidico e lipidico in donne con pregresso diabete gestazionale.
No full textInsulin requirements and carbohydrate to insulin ratio in normal weight, overweight, and obese women with type 1 diabetes under pump treatment during pregnancy: a lesson from old technologies
Full text linkAim:The primary aim of this study was to assess insulin requirements and carbohydrateto insulin ratio (CHO/IR) in normal weight, overweight, and obese pregnant women withtype 1 diabetes across early, middle, and late pregnancy.Methods:In this multicenter, retrospective, observational study we evaluated 86 of 101pregnant Caucasian women with type 1 diabetes under pump treatment. The womenwere trained to calculate CHO/IR daily by dividing CHO grams of every single meal byinsulin units injected. Since the purpose of the study was to identify the CHO/IR able toreach the glycemic target, we only selected the CHO/IR obtained when glycemic valueswere at target. Statistics: SPSS 20.Results:We studied 45 normal weight, 31 overweight, and 10 obese women. Insulinrequirements increased throughout pregnancy (p < 0.0001 and <0.001 respectively) inthe normal and overweight women, while it remained unchanged in the obese women.Insulin requirements were different between groups when expressed as an absolute value,but not when adjusted for body weight. Breakfast CHO/IR decreased progressivelythroughout pregnancy in the normal weight women, from 13.3 (9.8–6.7) at thefirst stageof pregnancy to 6.2 (3.8–8.6) (p = 0.01) at the end stage, and in the overweight womenFrontiers in Endocrinology | www.frontiersin.orgFebruary 2021 | Volume 12 | Article 6108771Edited by:Elena Succurro,University of Magna Graecia, ItalyReviewed by:Cristina Bianchi,Azienda Ospedaliero-UniversitariaPisana, ItalyMaria Grazia Dalfra’,University of Padua, Italy*Correspondence:Camilla [email protected] section:This article was submitted toObesity,a section of the journalFrontiers in EndocrinologyReceived:27 September 2020Accepted:14 January 2021Published:25 February 2021Citation:Festa C,Fresa R,Visalli N,Bitterman O,Giuliani C,Suraci C,Bongiovanni M andNapoli A (2021)Insulin Requirements andCarbohydrate to Insulin Ratio inNormal Weight, Overweight, andObese Women With Type 1Diabetes Under Pump TreatmentDuring Pregnancy: A LessonFrom Old Technologies.Front. Endocrinol. 12:610877.doi: 10.3389/fendo.2021.610877ORIGINAL RESEARCHpublished: 25 February 2021doi: 10.3389/fendo.2021.610877
from 8.5 (7.1–12.6) to 5.2 (4.0–8.1) (p = 0.001), while in the obese women it remainedstable, moving from 6.0 (5.0–7.9) to 5.1 (4.1–7.4) (p = 0.7). Likewise, lunch and dinnerCHO/IR decreased in the normal weight and overweight women (p < 0.03) and not in theobese women. The obese women gained less weight than the others, especially in earlypregnancy when they even lost a median of 1.25 (−1−1.1) kg (p = 0.005). In earlypregnancy, we found a correlation between pregestational BMI and insulin requirements(IU/day) or CHO/IR at each meal (p < 0.001 and p = 0.001, respectively). In latepregnancy, a relationship between pre-gestational BMI and CHO/IR change was found(P = 0.004), as well as between weight gain and CHO/IR change (p=0.02). Thesignificance was lost when both variables were included in the multiple regressionanalysis. There was no difference in pregnancy outcomes except for a higher pre-termdelivery rate in the obese women.Conclusion:Pre-gestational BMI and weight gain may play a role in determining CHO/IRduring pregnancy in women with type 1 diabetes under pump treatment
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
- …
